Pharmacy-PBM model may aid patients' health in the long-run

By Antoinette Alexander

WHAT IT MEANS AND WHY IT'S IMPORTANT The fact that CVS Caremark presented research highlighting the benefits that pharmacy benefit management tools can have on improving medication adherence is important on several different levels.

(THE NEWS: CVS Caremark research highlights methods for improving medication adherence. For the full story, click here)

CVS Caremark has had some challenges on the PBM side of its business, and while it appears to be doing a better job selling to big payers these days, it still has been the subject of scrutiny by some who have questioned the vertically integrated pharmacy-PBM model. Studies, such as those presented at the 22nd Annual Meeting of the Academy of Managed Care Pharmacy, are meant to demonstrate the value of that structure at a critical time.

As reported by Drug Store News, one of the more recent snags is a bill that would prohibit federal PBM contracts with companies that operate both a PBM and retail pharmacies. It not only has sparked debate but, if passed, could be a blow to the vertically integrated pharmacy-PBM model.

Some critics are calling for PBM reform within the Federal Employees Health Benefits Program, claiming that PBMs have unclear pricing methods, retain most discounts or rebates prescription drug manufacturers give them, and receive little oversight from the Office of Personnel Management. The bill, which was introduced in January, now has been sent to the Committee on Oversight and Government Reform for consideration.

But many, including the OPM, have spoken out in opposition to the bill, stating that it would impose "significant administrative costs" that could be passed on to federal employees.

By continuing to highlight the benefits of the vertically integrated pharmacy-PBM model, and by introducing research to support its claims, CVS Caremark is banking that its message will continue to resonate.

Meanwhile, an article in the prestigious New England Journal of Medicine by two healthcare policy opinion leaders is fueling the message that pharmacy's role in helping patients take medications correctly is key to improving lives and reducing long-term healthcare costs.

"Pharmacy plays a critical role in helping patients take the right medications and take them correctly," stated NACDS president and CEO Steve Anderson. "As the face of neighborhood health care, pharmacists are uniquely qualified to help patients understand the importance of following their medication regimens properly. Working together, pharmacists and patients can improve health care for individuals and for the system overall through reduced costs."

The reality is that there's a great deal at stake -- not only patients' health but a staggering $300 billion annual drain on the U.S. healthcare system due to poor medication adherence, which frequently is at the root of preventable hospitalizations and patient illness.